Francophone - Webagoo.eu

C 30
QUAND RECOURIR A « L’ULTRA CONVENTIONNELLE » : L’EXEMPLE ITALIEN
ULTRA CONVENTIONAL THERAPY: ITALIAN EXPERIENCE
POST INFARCTION CARDIOGENIC SHOCK
M.RAIMONDI - G.PAMPLONI - A.DEGANI - A.BRANCAGLIONE - A.COMELLI - M.GUERCI
S.CORTESI, Pavia - ITALIE
Cardiogenic Shock after Myocardial Infarction and Cardiac Arrest (CA) are a major cause of death of the
modern era and the survival from Cardiac Arrest outside the hospital remains very low. The standard protocol
for responding to a cardiac arrest (called the“Chain of Survival”) involves four key links: early access to an
emergency medical system, early cardiopulmonary resuscitation (CPR), early defibrillation, and early access
to advanced cardiac life support.
When there is no return to spontaneous circulation despite a complete ACLS procedure, the out of -hospital
“ultra conventional” therapy has the goal to maintain an high quality CPR also with the use of automatic
mechanical compressor (AutoPulseTM, ZOLL). During CPR continuous waveform ETCO2 and invasive blood
pressure for Coronary Pressure Prefusione (CPP) monitoring were performed as an indirect measurement
of high quality CPR, and the use of portable echocardiography make to possible an early diagnosis and
transport the patient into the Emergency Department (ED).
If there is ROSC, it is very important to start Mild Hypotermia for neuro protection as soon as possible,
directly in Prehospital setting, for arriving into ED with a core temperature of 34-35°, limiting O2 ventilation
for reaching a SatHbO2 not higher than 94-98%.
In the hospital this extreme patient with a long time Cardiac Arrest without ROSC (>60 minutes), has low
chances of survive. In our experience the use of Authomatic Mechanic Compressor improve of diastolic BP as
well as systolic and mean BP and allowed to performing PTCA for remove coronary occlusion or CT scanner
in CA patients for know and treat the cause of CA and could allows to gain time to establish a system ECMO
as ultra advanced link to the chain of survival.
Conclusions
The treatment of cardiogenic shock in myocardial infarction out of a hospital is still a very critical situation
complicated of a possible cardiac arrest with high mortality. During ACLS the Automated CPR devices
Autopulse® may play an increasingly important role in CPR in the future because they assure of a constant
quality in accordance with the new ILCOR recommendations.
AREU Lombardia, AAT 118 Pavia, Fondazione I.R.C.C.S. Policlinico S.Matteo, Pavia Italy
*CCP, Cardiothoracic Suregery Fondazione I.R.C.C.S. Policlinico S.Matteo, Pavia Italy
C 31
CHOC CARDIOGÉNIQUE POST-INFARCTUS - POST INFARCTION CARDIOGENIC SHOCK
G.GROLLIER, Caen
Si la fréquence du choc cardiogénique post-infarctus a diminué du fait d’une prise en charge plus rapide et
plus efficace de l’infarctus du myocarde avec une utilisation plus fréquente des technique de revascularisation,
le pronostic du choc cardiogénique installé reste toujours aussi mauvais. En effet si dans 30% des cas le choc
cardiogénique est dû à une complication mécanique et relève d’un traitement chirurgical, dans 70% des cas
il est lié à une atteinte myocardique extensive et l’angioplastie lorsqu’elle est réalisable est le traitement de
choix avec cependant un taux de mortalité élevé.
Dans ce contexte, d’une part aucune approche médicamenteuse n’a actuellement fait la preuve de son
efficacité, d’autre part la pertinence des techniques d’assistance circulatoire (y compris de la contrepulsion
diastolique) reste à prouver.
Cependant deux approches sont à privilégier : la prévention du choc par des revascularisations encore
plus rapide et la mise en place de réseaux de prise en charge régionales de ce type de choc ou préchoc,
associant assistance circulatoire, hypothermie, pré et post conditionnement et revascularisation la plus rapide
possible.
40 Congrès Francophone de Cardiologie Interventionnelle 2011